NHS Stories: Work asthma

In the second of a series of articles BBC News Online reporter Jane Elliott looks behind the scenes of the NHS.

This week we focus on the story of a joiner whose allergy to wood was causing his asthma.

When general maintenance man Eric Beeton was made redundant in his late 50s, he was delighted to get another job as a joiner.

He was taken on by a firm making garden sheds.

But within months his health started to deteriorate, leaving him wheezing and coughing and requiring treatment at the Royal Brompton Hospital, London.

He had developed a severe form of asthma and started to seriously worry about his health.

Allergy

Eric, 63, from near Cambridge, was convinced that one type of wood - Western Red Cedar - was responsible for all his troubles.

"After working with it I felt like I had walked into a brick wall, I could not get my breath.

He started to rattle during the night and that really frightened me Ann Beeton

"At first I used to get better at the weekends, but at the end I had the symptoms all the time.

"I was terribly wheezy. I was bringing up sputum and within a couple of hours at work I would feel that my lungs had seized up.

"I went to my GP and he said that I had occupational asthma."

His wife Ann said she had been terrified by Eric's worsening health problems.

"It got a lot worse at night he started to rattle during the night and that really frightened me."

Tests

When a team were visiting from the Health and Safety Executive (HSE) Eric told them of his problems.

They got him referred to a specialist and his case was eventually transferred to the Royal Brompton for diagnostic tests.

In their specially adapted laboratories staff were able to recreate Eric's working conditions to see which wood, if any, was causing his problems.

He said: "They found what I suspected, I knew that my problems were with the cedar.

Although I had thought this was the problem, I could not be sure because I was working with pinewood as well.

"I found that the wetter the wood was the worse the problems and the worse I became affected. I think I had so many problems with this wood because it contains natural preservatives."

Now his boss has changed the way Eric works to ensure he does not come into contact with the cedar.

But Julie Cannon, clinical nurse specialist in occupational and environmental medicine, at the Royal Brompton, explained that for many patients with occupational asthma their bosses are not so understanding.

"A lot of people end up leaving their work or they are sacked.

"When they have been diagnosed as having a problem with a particular substance then we have to tell them that they can never work with that substance again.

"That is often very difficult for them because it means that some of them have to rethink their whole careers.

"The problem with carrying on working with something that you are allergic to is that what happens is that over time you become worse and worse.

"And then your case becomes chronic. It will deteriorate in time and if you leave it too late then it will not be reversible."

Cases

But Julie admitted that there was some reluctance on the part of employees and employers to admit a problem with occupational asthma.

"There is a bit of stigma attached to a diagnosis of occupational asthma by some employers who can see an employee with the condition as a potential liability."

Each year Julie's clinic has 250 new referrals, cases referred to the hospital from all over the UK.

The national reporting scheme SWORD, says that there are 2,000 new cases each year, but it is thought that this hides a three-fold underestimation of cases.

These are patients who have developed asthma as an adult and where there is a concern that their illness is linked to their work.

Julie and the team look at how the patient is breathing, when their illness is at its worse.

Cases dealt with at the Royal Brompton include bakers who are allergic to the flour they use, paint sprayers who can not use their paints and people working on making detergents who develop allergies to the enzymes.

For some patients, like Eric, it is difficult to pinpoint or prove exactly which substance they work with is causing the problems.

So the team recreates their working conditions.

Julie said: "We try to recreate what they are doing at work and see what happens to them and see if that particular substance has caused them to have asthma.

"It is important for the patient to be diagnosed early because occupational asthma is a preventable condition.

"The longer the patient is working with the substance before it is diagnosed the longer it will take them to recover. And if it is left a very long time then their lungs may never recover."